Reirradiation combined with hyperthermia in breast cancer recurrences: Overview of experience in Erasmus MC

Figures & data

Figure 1. The superficial hyperthermia treatment set-up. The technician observes both the patient and the temperature and power information. The PC screens show, from left to right (A) the course of temperatures over time, per applicator; (B) the drawing of the treated area with location of applicators and actual temperature per measuring site (details are shown in Figure 3B), and (C) the power output per applicator.

Figure 2. Close-up of the applicators placed above the thoracic wall, on top of the perfused water bolus.

Figure 3. (A) A patient under treatment, with recurrent breast cancer on the ventral and lateral thoracic wall. This patient was treated with two applications.

Figure 3. (B) An example of the middle PC screen during treatment with the drawing of the ventral treatment area. The drawing shows the tumour tissue, the mastectomy scar, four interstitially placed catheters, the footprints of the applicators, and actual interstitial (in bold) and superficial temperatures.

Table I.  Results of reirradiation and hyperthermia in recurrent breast cancer

Reference	RT dose and scheme	HT technique and scheme	CR after RT (total n), %	CR after RT+HT (total n), %
35	F 2-2.5, T 20-30, 3/wk	A 2450, R-H, D 35-40, N 6-8		(15) 53%
36 *M, *reRT 72%	F 3, T 30, 5/wk	A 2450, 915, R-H, D +45, N 4	(17) 35%	(28) 64%
37	F 4, T 24, 2/wk	A 433, R-H, D 60, N 6		(26) 77%
38 *R	F 2, T 35-75, 5/wk	MW or RF, D 40, N 4-8	(10) 40%	(9) 67%
39	F 4, T 32, 2/wk	A 200-700, R-H, D 60, N8		(30) 57%
40	F 2-2.5, T 20-80, mean 47	A 915, 2450, R-H, D 40, N mean 12		(20) 80%
41	F 3.5-4.5, T 30-41, 2-3/wk (7 pts T < 30)	A 2450, R-H, D +45, N 3-10		(34) 65%
42	9 pts F 1.8-2, T 20-58 4 pts F 4, T 28-44	A 430,2450, 8 or 13.5, R-H, D 30-60, N 2-10, mean 6		CR+PR > 80% (13) 92%
26 91 *R	F 4, T 32, 2/wk	A 915, R-H, D 60, N 8	<3 cm (10) 40% >3 cm(29) 28%	(13) 62% (29) 21%
43	F2-5, T 16-56, mean 29.4, 2-5/wk	A 300-1000, R-H, D 60, N 2-9, mean 5		(44) 41%
21	F 3, T 30, or F 2.3, T 34.5, 5/wk	A2450, 915, R-H, D +45, N 4, 3 or 6		(69) 71%, no difference between 3 schemes
44	F 1.8-5.2, T 8-68, 2-5/wk ETD mean 42	A 915 patchwork, D 60, N 1-5, mean 1.3		(20) 95%
1 (ESHO) *R	F 4, T 32, 2/wk	A 433, R-H, D 60, N 4-8	(29) 38%	(27) 78%
1 (MRC-BrR) *R, reRT 81%	F 3.6, T 28.8, 4wk 28 pts T > 33 Gy	A 433, 2450, R-H, D 10+60, N 3	(59) 29%	(90) 57%
1 (PMH) *R, *reRT 61%	F 1.8, T 32.4, 5/wk 13 pts T 51-60	A 915, R-H, D15+30, N 2	(16) 31%	(17) 29%
45 *reRT 51%	F1.8-2, T2-70, median 46.5, 5/wk, or F 4, T20-66, median 32, 2/wk	915 (few 60-130 or US), R-H, D +45, N 1-11 median 8		(178) 63%
25	F 4, T 32, 2/wk	A 2450, R-H, D 60, N 8 A 433, R-H, D 60, N 8		(24) 58% (95) 74%
46	F 2-4, T 30, 3/wk	A 915 or US, R+H simultaneously, D 60, N 1-6 mean 3.3		(15) 79%
47	F 1.2-2, T 36-60, mean 45, 5-9/wk, *C	A 915, R-H, D 60, N 1-5 mean 3.9, HT simultaneously with chemotherapy		(18) 22%
48	F 1.8, T 30.5, 5/wk, *C	A 433, R-H, D 60, N 6, HT simultaneously with chemotherapy		(15) 20%
49	F 1.8-2, T 30-40, 5/wk	A 915, R-H, D 45, N 2-6		(24) 42%
50	F 1.8-2, T 12-74, median 43, 5/wk	A 8, 13.5, 430, 2450 or US, R-H, D 30-60, N 2-9 mean 4.5		(41) 56%
51	F ∼2, T14-72, median 48, 5/wk	Multi-institutional review; no details on HT treatment reported		(36) 67%
52	F1.8-2, T20-60 mean 31.8	A 433, R-H, D +30, N median 6		(44) 66%
Summation			(170) 32%	(974) 61%

Legends to Table I:

*M: matched lesions.

*R: randomized study.

*reRT: % of patients that was reirradiated

RT = radiotherapy; dose and scheme: F = fraction size; T = total dose in Gy, n/wk = number of fractions per week.

*C: treatment schedule included chemotherapy as well.

ETD = equivalent total radiation dose based on linear quadratic model.

HT = hyperthermia; A = application technique: microwave frequency, US = ultrasound, MW = microwave equipment and RF = radiofrequency equipment, not otherwise specified; scheme R-H= HT after RT, D = duration per treatment in minutes (+: extra heating-up time), N = number of treatments.